Background: Breast and cervical cancer screening have been underutilized by older Hispanic women. No study has simultaneously examined these screening behaviors as a multinomial outcome. Objective: Investigate factors affecting the combined receipt of mammogram and Pap test among older Mexican-American women. Methods: A multinomial logistic regression analysis of data from a sample of 442 Mexican-American women ages 50-75 in southeast Texas. Data on mammogram and Pap test use were collected with face-to-face interviews from 1997 to 1999. Results: 48.4% of studied women had both a mammogram and Pap test regularly, 10.6% had mammograms more often than Pap tests, 24.0% had Pap tests more often than mammograms and 17% concordantly underutilized both mammogram and Pap test. A positive attitude toward preventive care and having a usual source of care increased the odds of receiving both screenings regularly. Women with a higher acculturation level were less likely to receive both procedures regularly. Compared to women having both screenings regularly, those who had mammograms more often than Pap tests had more daughters and a higher familism level. Those who had Pap tests more often than mammograms had a bigger household size. Conclusion: Having a usual source of care and positive attitudes toward preventive care promote having both screening procedures performed on a regular basis. The association between acculturation and routine cancer screening is more complex than previously documented. Our findings suggest that breast cancer screening among older Mexican American women might be enhanced through family oriented interventions.